12 Tips to Improve your Practice’s Billing and Collection Performance

Practices that have high hopes of improving the performance of billing and collection in an insurance claims work sphere should find this guide of basic instructions useful. The resource of ideation aims to eliminate common errors of practices; as observed in a study focused on insurance billing and collection.

Verify eligibility

Verify eligibility

1. Verification of insurance coverage and eligibility.

All registered patients should have a completed profile in the practice’ PMS (Patient Management System). The paramount goal of enforcing this protocol is to gather correct personal data from patients. This includes covered insurance and copayments. The support staff should record the latest insurance data and verify that it’s an active premium using an automated processing solution.

2. Pre-authorized payment processing and approvals.

Some health insurance policies such as HMO (Health Maintenance Organization) premiums require preauthorization before an insurer approves the claim. Coverage for procedures such as oculoplastics, retinal surgery, and pediatrics fall under this umbrella. A practice should exercise prudence in getting a coverage approved within the 48-hour window before treating a patient. It’s a practical measure to minimize the risk of lost revenue.

 

Patient data

Patient data

3. Verification of patient insurance data on arrival.

Modern card scanning software used in practice management feature advanced settings for insurance image processing and data storage. It’s a security protocol to improve accuracy and proper verification of patient information. It increases processing time for new and returning patients. This payment processing solutions complement front desk operations and increase employee efficiency.

4. In- office copayment processing and collection.

It’s of utmost importance that the practice staff process collectible deductibles, copayments, and noncovered services at the point of treatment. It’s risky to send an invoice for collection after treatment. Numerous practices have failed to collect payments in similar situations.

 

Insurance Claims Auditing

Insurance Claims Auditing

5. Weekly auditing of processed charges report.

It’s a duty to keep things organized in a medical practice facility. With an efficient PMS in place, billing and collection is a breeze. It’s an efficient record keeping method to make a comparison of receivables and patient appointment records.

6. Charge entry checking.

Billers and coders in practice should review all provider-entered transactions before submission. Today’s methods of IEMR (Integrated-Electronic-Medical-Record) management tools include advanced features that allow a practice keep every bit of patient data safe and organized. It makes checking for unauthorized modifiers and errors easier. Medical professionals that incorporate this upgrade into practice encounter fewer denials and revenue losses.

 

calculate fees

calculate fees

7. Fee allowance and assessment.

Some practices run into problems because of incorrect fee calculation. It’s imperative that he or she sets a reasonable fee to get a full compensation for medical service. A sound approach to guarantee 100% satisfaction in using this fee scheduling method is to set a higher fee.

8. Record entries and process charges instantly.

In medical practice, record keeping is a duty, but it’s of utmost importance that the staff records each transaction promptly. This is to limit the risk of errors and nonpayment. A practice should put an efficient PMS in place to avoid encountering such problems.

 

insurance claims

insurance claims

9. Automated insurance claims editing.

It’s easier to edit insurance claims in a PMS to minimize errors and increase productivity. This decreases the risk of insurance claims rejection. If the existing PMS being used doesn’t support auto-editing, a practice should explore a third-party solution. It’s a useful billing and collection solution to increase accuracy.

10. Claims submission scheduling.

In a billing and collection setting, it’s imperative that the staff submit all claims to the clearinghouse by the end-of-business. Some practices schedule this activity on tri-weekly basis. It’s imperative to keep a consistent schedule when managing claims submission. If a practice office fails to keep a time-efficient scheduling system in place; he or she is likely to have payments delayed, claims adjudicated or rejected.

 

Claim Rejection

Claim Rejection

11. Clearinghouse rejection review.

A crucial aspect of billing and collection is ensuring that all claims have undergone stringent background checks. Sometimes, a biller or coder forgets to review rejected claims. It’s an essential billing and collection management rule that a coder/biller checks all rejected claims within 24 hours after submission.

12. Payment posting review.

This part of billing and collection from an insurance standpoint involves a sequence of processes for successful payment posting. Electronic remittance and work rejection control play a key role in effecting a smooth payment posting experience. As the staff encounters rejections, it’s imperative that they address the problem immediately. They should also check the database to identify all unpaid and rejected claims to gauge the correctness of entries.

Written guide

Written guide

 

This helpful guide puts emphasis on effecting positive change in a billing and collection work sphere. Practices that fail to implement efficient management of insurance claims and payments are likely to lose revenue. The steps aren’t complication and should encourage workforce efficiency. The presence of a PMS guarantees a smooth process as well.

We’re glad you read our post. If you have any feedback, please share it below. If you need cms 1500 02/12 to file insurance claims, head over to Justcms1500forms.com. Personally, I prefer to purchase Cms 1500 version 02/12 forms for my practice from a manufacture (like they are), instead of a re-seller who doesn’t guarantee their product. For those of you that file more than average numbers of claims, they offer software for that as well. Look out for my next article soon.

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